Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC.
Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2019 May;82(5):351-355. doi: 10.1097/JCMA.0000000000000078.
Cardiovascular disease is a major cause of mortality in patients with end-stage renal disease (ESRD). In addition to arteriosclerosis (arterial stiffness) and atherosclerosis, left ventricular (LV) hypertrophy and LV systolic dysfunction are the major cardiac determinants of cardiovascular mortality in hemodialysis patients. Although LV diastolic dysfunction is common in patients with ESRD, its prognostic value is yet to be established.
A total of 103 ESRD patients (52 females, 51 males, age 51 ± 14 years) receiving regular hemodialysis and with preserved LV systolic function were prospectively enrolled in the current study. A comprehensive cardiovascular evaluation was performed at baseline. LV diastolic function was assessed using Doppler mitral inflow velocity and tissue Doppler imaging (TDI) of the mitral annulus velocity. Predictors for hospitalization and all-cause mortality were identified via Cox proportional hazards analysis.
There were 20 deaths and 46 hospitalizations during a follow-up period of 67.9 ± 20.2 months. After adjusting for age, aortic pulse wave velocity (PWV), and carotid intima media thickness, Cox analysis demonstrated that ratio of early ventricular filling velocity (E) to early diastolic tissue velocity mitral annulus (E') (E/E') was a significant predictor for hospitalization (hazard ratio [HR] 1.235 and 95% CI 1.115-1.368 per-1SD). E' also independently predicted mortality (HR 0.682, 95% CI 0.472-0.985). The TDI parameters significantly correlated with the LV mass index and PWV.
The findings of the current study suggest that diastolic function, as indexed by TDI, is an independent predictor of hospitalization and mortality in ESRD patients receiving regular hemodialysis and with preserved LV systolic function. The TDI parameters may reflect the impairment of arterial function and LV pressure overload.
心血管疾病是终末期肾病（ESRD）患者死亡的主要原因。除动脉硬化（动脉僵硬）和动脉粥样硬化外，左心室（LV）肥大和 LV 收缩功能障碍也是血液透析患者心血管死亡的主要心脏决定因素。尽管 ESRD 患者中常见 LV 舒张功能障碍，但尚未确定其预后价值。
本研究前瞻性纳入了 103 名接受常规血液透析且 LV 收缩功能正常的 ESRD 患者（52 名女性，51 名男性，年龄 51 ± 14 岁）。在基线时进行了全面的心血管评估。使用多普勒二尖瓣流入速度和二尖瓣环组织多普勒成像（TDI）评估 LV 舒张功能。通过 Cox 比例风险分析确定住院和全因死亡率的预测因素。
在 67.9 ± 20.2 个月的随访期间，有 20 人死亡，46 人住院。在校正年龄、主动脉脉搏波速度（PWV）和颈动脉内膜中层厚度后，Cox 分析表明，早期心室充盈速度（E）与早期舒张组织速度二尖瓣环（E'）的比值（E/E'）是住院的显著预测因素（每 1SD 的风险比 [HR] 为 1.235 和 95%CI 为 1.115-1.368）。E'也独立预测死亡率（HR 0.682，95%CI 0.472-0.985）。TDI 参数与 LV 质量指数和 PWV 显著相关。
本研究结果表明，TDI 指数评估的舒张功能是接受常规血液透析且 LV 收缩功能正常的 ESRD 患者住院和死亡的独立预测因素。TDI 参数可能反映了动脉功能障碍和 LV 压力超负荷的损害。
